Nerness v. CHRISTIAN FIDELITY LIFE INS.

733 So. 2d 146, 1999 WL 228822
CourtLouisiana Court of Appeal
DecidedApril 21, 1999
Docket98-1827
StatusPublished
Cited by13 cases

This text of 733 So. 2d 146 (Nerness v. CHRISTIAN FIDELITY LIFE INS.) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Nerness v. CHRISTIAN FIDELITY LIFE INS., 733 So. 2d 146, 1999 WL 228822 (La. Ct. App. 1999).

Opinion

733 So.2d 146 (1999)

Steven & Mary NERNESS, Plaintiffs—Appellees,
v.
CHRISTIAN FIDELITY LIFE INSURANCE COMPANY, Defendant—Appellant.

No. 98-1827.

Court of Appeal of Louisiana, Third Circuit.

April 21, 1999.

*148 Mark Terrance Hoychick, Eunice, for Steven & Mary Nerness.

Edward Benjamin Dubuisson, Opelousas, for Christian Fidelity Life Insurance Company.

BEFORE: SAUNDERS, WOODARD, and DECUIR, Judges.

WOODARD, Judge.

In this insurance coverage case, Steven and Mary Nerness filed a petition against Christian Fidelity Life Insurance Company (CFLIC), their health insurance provider, alleging that CFLIC underpaid some of their claims and that payment was made within delays exceeding those tolerated by Louisiana law. The Nernesses also alleged that CFLIC wrongfully terminated dependent coverage of their son, Steven Allen, and their daughter, Misty Dawn. The trial court ruled in favor of the Nerness family, awarding benefits and penalties. CFLIC appeals. We affirm.

FACTS

Steven Nerness, a minister for a Missouri based religious organization, the Assemblies of God (TAG), and Mary, his wife, dedicated their lives to work as missionaries with American Indians.

Through the division of Home Missions of TAG's general counsel, the Nerness family, while residing in Webster City, Iowa, was made beneficiary of a group hospital and medical insurance policy issued by CFLIC, bearing No. DHM87, Certificate No. 61, with an effective date specified for March 8, 1988. The Nernesses' four children, Steven Allen, born February 2, 1972, Misty Dawn, born July 28, 1976, Israel Joshua, born January 16, 1980, and Jacob Harlan, born September 27, 1984, were insured under the CFLIC policy's dependent coverage provision, which set forth the following:

Section 2 DEFINITIONS
2.1 "Dependent" means only the following persons who are not otherwise eligible as Members:
. . . .
2.1.1b. Each unmarried child of the Member who lives with and is dependent upon the Member for the child's main support and care and who is 15 days or over but less than 19 years of age. If upon reaching age 19 such child is covered as a *149 dependent and is a full-time student in high school or in a degree program at an accredited college, he may continue his coverage under the Policy, provided written application is made to the Company and the required premium, if any, is paid within 31 days after the child reaches the limiting age. The insurance of such child shall terminate automatically on the earliest of the dates shown in the Termination of Dependent Insurance provision below....
. . . .
Section 3 ELIGIBILITY AND EFFECTIVE DATE
. . . .
3.9 TERMINATION OF DEPENDENT INSURANCE
. . . .
3.9.2. With respect to medical and health insurance, if an unmarried child upon reaching age 19 is covered as a dependent and is a full-time student in high school or in a degree program at an accredited college, dependent insurance may be continued, provided written application is made to the Company and the required premium, if any, is paid within 31 days after the date such child reaches the limiting age. Dependent insurance on such child shall not continue past the earliest of the following dates:
a. the date when the child first ceases to be currently enrolled as a full-time student in high school or at an accredited college during a regular semester, excluding summer sessions; or....

(Emphasis added).

The family was assigned to work with the Sioux Indians and moved to Mobridge, South Dakota, where they purchased a home. For a twenty-seven-month period, they were subjected to hydrogen sulfite and methane sewer gases leaking through a broken copper pipe located in their basement. It is undisputed that the exposure resulted in severe disabling health problems for the entire family. A report from Dr. Thomas Callender, a specialist in internal medicine and occupational/environmental toxicology from Lafayette, Louisiana to whom the family was later referred, explained that the entire family had "respiratory and neurological problems" and recommended that the entire family be seen by a "neuro-psychologist for testing."

Prior to these findings, in the spring of 1992, Steven Allen became so ill that he was unable to complete the semester for which he was enrolled as a full-time student at the Central Indian Bible College (CIBC). A report issued on October 16, 1992, by Thomas Jurek, a practicing nurse at the Mobridge Family Practice, establishes that Steven Allen was unable to attend CIBC as a result of methane gas poisoning. Eventually, Steven Allen's health improved, and he was able to enroll and complete the following fall semester of 1992. Nevertheless, because he was unable to complete a semester of college, CFLIC dropped Steven Allen from coverage, but reinstated him in April of 1993. However, from then on, CFLIC denied any of his gas poisoning related claims. CFLIC informed Steven Allen that the coverage that he was provided in April of 1993 was new coverage to which the preexisting condition exclusions of the policy applied.

While in South Dakota, the Nerness family was referred to Dr. Callender. First, Dr. Callender treated the Nerness family in South Dakota, then, in June of 1993, Mr. Nerness accepted a ministry with the Coushatta Indians in Elton, Louisiana, primarily to allow his family to follow treatment with Dr. Callender. On April 13, 1993, Dr. Callender issued a report wherein he described the effects of gas poisoning on Misty to be as follows:

Misty became sick almost overnight with fatigue, headaches, nausea, body ache, shortness of breath, coughing, *150 chest tightness. Other (sic) symptoms developed such as, legs cramping up, continued nausea, joint stiffness, rapid heart beat, shallow rapid breathing [...] sinus congestion, sleeping problems, odor intolerance, severe headaches at least twice a week, sore throats, dry cracked lips. She has problems concentrating, malaise, and extremely cold extremities.

Misty graduated from high school in the spring of 1994 and enrolled at Louisiana State University Eunice (LSUE) the following fall. She turned nineteen on July 28, 1995, following which gas poisoning health-related problems kept her from completing the fall semester of 1995. The family moved back to Iowa, and Misty enrolled at Iowa State University (ISU) for the spring semester of 1996 for which she had received a scholarship. Again, her gas poisoning generated infirmities which kept her from completing another semester. Apparently, she could only walk a block before becoming short of breath. She had kidney infections, recurring pneumonia, and congestive heart failure.

Misty obtained an electric wheelchair through the State of Iowa's vocational rehabilitation services, following which she was able to enroll in college and successfully follow her curriculum. Nevertheless, because she was unable to complete a full semester of college, CFLIC terminated Misty's dependent coverage, effective December 31, 1995.

The Nernesses initially filed a petition against CFLIC on September 29, 1994. Their petition was amended on February 6, 1997. Pursuant to a hearing held March 19, 1997, the trial court entered judgment on September 16, 1998.

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Bluebook (online)
733 So. 2d 146, 1999 WL 228822, Counsel Stack Legal Research, https://law.counselstack.com/opinion/nerness-v-christian-fidelity-life-ins-lactapp-1999.